Know all about Liver Transplant!

The Liver is a vital organ. Located in the abdomen below the right side of the rib cage, it is also the largest internal organ, weighing around 1.3 Kg in an average adult. The gallbladder holds the bile and is located below the liver. Bile is carried from the liver by the bile ducts to the intestine.

What Does the Liver Do?
The liver has multiple functions, almost over 100, many of which are very complex and essential to life. What we eat, drink, breathe and absorb is processed by the liver. Some of the important functions are:

Production and secretion of bile, which aids in digestion and absorption of fats.

Control the body’s ability to clot blood.

Help fight infections.

Production of proteins needed by the body.

Help regulate hormones.

Storage of energy to fuel muscles.

Storage and release of glucose, vitamins and minerals.

If some of the functions of the liver cease, the body may not live for more than 24 hours! Even a small disturbance in the functions of the liver can have profound and possibly life-threatening effects on the body.

When Do You Know there are problems?
Many conditions can cause the liver to become diseased or to cease functioning properly. Some signs of liver problems are:

Losing appetite.

Feeling sick in stomach.

Losing weight.

Bruising or bleeding easily, like nose bleeds.

Declining mental functions.

Liver problems often make the skin and the whites of the eyes turn a shade of yellow, especially during jaundice, and may cause swelling in the legs and the abdomen. Not all patients with liver disease will need to have a liver transplant. Some liver diseases respond well to treatment with medicines. Your doctor will determine whether a liver transplant is necessary and recommended.

What is Liver Transplantation?
Liver transplantation is a surgery to remove the diseased liver and replace it with a healthy one. It is usually indicated for persons whose liver disease is so advanced that other forms of medical treatment will not provide a good quality of life. Good medical care and treatment can delay but not eliminate the need for a liver transplant.

This kind of surgery is almost four decades old, around the world. Many people who have had liver transplants now lead normal lives.

Where Do The Livers For Transplants Come From?
The liver that one needs for the liver transplant can come from two sources:

Living Donor:A healthy person can donate part of his or her liver. In living donor transplantation, a segment of a healthy person’s liver is transplanted into the sick patient. This can be done because liver is the only miraculous organ that can regenerate itself: both the donated segment and the remaining section of the donor’s liver will grow to the normal size within weeks!

Cadaveric Donor:Whole livers come from people who have suffered brain damage resulting in death. All donor livers have to be tested before transplant surgery. The testing makes sure that the liver is healthy, matches the blood type and is the right size. The potential donor is evaluated very carefully for disease, infection or trauma before considering for the donation.

Is a Liver Transplant For Everyone?
One cannot have a transplant if he has any of the following problems:
1. Cancer in another part of the body.
2. Severe heart, lung or nerve disease.
3. Active alcohol or illegal drug abuse.
4. An active severe infection.
5. Inability to follow the doctor’s instructions.

Transplanting the Liver

The recipient is evaluated thoroughly to find out the cause of the liver disease. His other body systems are evaluated to check his fitness to undergo the procedure.

When the liver is available, the recipient will be prepared for the transplant. If the liver is from the living donor, both would be in the surgery at the same time. If the liver is from the brain-dead donor, the surgery would start when the liver arrives at the hospital.

The surgery is long – about 6 to 14 hours. While the surgeon removes the diseased liver, another surgeon prepares the new liver. The new liver is placed in the place of the removed diseased liver. The surgeon reconnects the blood vessels and the bile ducts so that the blood then flows into the new liver.

After surgery, the recipient stays in the hospital for an average of two to three weeks, to be certain that the new liver is working. Medicines are given to prevent rejection of the new liver and to prevent infections. The doctor checks for bleeding, infection and rejection. During this time, the recipient and attendants learn about the medications and how to take care, once the recipient is sent home.

Rehabilitation

In Hospital
Activity: The patient’s progress is checked and the physiotherapist accordingly adjusts an exercise programme. The recipient starts with the passive exercise in the bed and is subsequently moved out of the bed and made to stand. Gradually, he walks and goes to the gymnasium.

Diet: The patient slowly starts eating again. He starts with a liquid diet and switches to solid food as the new liver starts to work. Before he leaves the hospital, the dietician reviews healthy eating guidelines and other information.

Discharge From Hospital
The recipient is expected to stay in close vicinity of the hospital to enable regular follow-up. The transplant team will have to provide lifelong support for the patient though. Regular visit to the clinic are an important part of the care after the patient leaves the hospital. He should pay attention to his body and mind and should call the transplant team when something isn’t right.

On follow up, the patient will have to visit the transplant clinic where the nurse will assess his overall condition, including diet and activity, answer his queries and review medications. The doctor will check the recipient’s progress, review blood tests and make changes in the medications.

Restoring Normalcy
After a successful liver transplant, most people can go back to their normal daily activities. Getting the strength back will take some time, depending on how sick the recipient was before the transplant.

Work: After recovery, most people are able to go to work.

Diet: Most patients are able to follow a normal, healthy meal plan with few or no restrictions. One may be advised to take calcium and vitamin pills. Research has shown that some people with a liver transplant have problems like weight gain, high blood fat and high blood sugar levels. Because of these reasons, it is important for the patients to strictly follow healthy eating guidelines.

Exercise: Most people can engage in physical activity after a successful liver transplant.

Sex life: Most people return to a normal sex life after liver transplantation. It is important for women to avoid becoming pregnant in the first year after transplant. They should discuss with the transplant team about sex and plans to conceive.